CAJ | 학술논문

目的通过鞍隔孔区结构的解剖学研究,分析经蝶入路脑脊液漏的发生机制,以及空蝶鞍(ES)的形成原因. 方法对8例胎儿标本进行组织学连续切片后,做HE和Masson染色,并在显微镜下对鞍隔孔附近结构进行观察;另取10例成人尸头标本,模拟经蝶入路手术,并在手术显微镜下观察鞍隔孔区解剖结构. 结果鞍上蛛网膜在垂体柄上端和其表面的软脑膜紧密结合,并转折进入鞍内;同时在垂体上表面处,鞍隔从四周紧密包绕并和表面的软脑膜紧密结合,而难以从组织学切片上分辨二者的界限:鞍上蛛网膜池由于蛛网膜、软脑膜和鞍隔的束缚而终止于鞍隔孔上部. 结论鞍隔、软脑膜和鞍上蛛网膜三者之间存在着严密的解剖学关系,其也是防止脑脊液漏和ES发生的关键因素.这三者的先天性缺损、生理性或者病理性破坏,尤其是在经蝶入路中对垂体腺瘤的过分牵拉,导致鞍上蛛网膜和软脑膜分离或者破裂,可能是造成术中脑脊液漏发生的重要原因;另外鞍隔、软脑膜和垂体上表面之间的分离也可能是造成ES的关键因素.
목적 통과안격공구결구적해부학연구,분석경접입로뇌척액루적발생궤제,이급공접안(ES)적형성원인. 방법 대8례태인표본진행조직학련속절편후,주HE화Masson염색,병재현미경하대안격공부근결구진행관찰;령취10례성인시두표본,모의경접입로수술,병재수술현미경하관찰안격공구해부결구. 결과 안상주망막재수체병상단화기표면적연뇌막긴밀결합,병전절진입안내;동시재수체상표면처,안격종사주긴밀포요병화표면적연뇌막긴밀결합,이난이종조직학절편상분변이자적계한:안상주망막지유우주망막、연뇌막화안격적속박이종지우안격공상부. 결론 안격、연뇌막화안상주망막삼자지간존재착엄밀적해부학관계,기야시방지뇌척액루화ES발생적관건인소.저삼자적선천성결손、생이성혹자병이성파배,우기시재경접입로중대수체선류적과분견랍,도치안상주망막화연뇌막분리혹자파렬,가능시조성술중뇌척액루발생적중요원인;령외안격、연뇌막화수체상표면지간적분리야가능시조성ES적관건인소.
Objective To perform an anatomical study of the structures around the diaphragmatic foramen and analyze the mechanism of cerebrospinal fluid leak and empty sella(ES).Methods With HE and Masson staining,the structures around the diaphragmatic foramen were observed microscopically on serial histological sections of 8 fetal specimens.The transsphenoidal approach was then simulated in 10 adult cadaver heads,and the structures around the diaphragnmatic foramen were observed under an operating microscope.Results The suprasellar arachnoid adhered tightly to the pia mater covering the upper part of the pituitary stalk,and folded into the sella through the diaphragmatic foramen.On the upper surface of the pituitary gland,the diaphragm adhered to the pia mater of the gland around the foramen,and their histological boundaries could not be distinctly identified on the serial sections.The suprasellar cistern terminated above the foramen due to the restriction by the arachnoid,pia mater and sellae diaphragma.Conclusion The close anatomic relationship between the sellae diaphragm,pia mater,and suprasellar arachnoid is critical to prevention of cerebrospinal fluid leak,and the breach of this anatomic relation,especially in the transsphenoidal approach for pituitary adenoma management that causes excessive traction of the tumor,results in separation or rupture of the arachnoid and pia mater,which can be an important factor contributing to cerebrospinal fluid leak.The separation of the sellae diaphragm,pia mater and the upper surface of the pituitary gland may also play an important role in the occurrence of ES.